Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 0106129 | KS |
NPI | 1134793268 |
---|---|
Provider Name | Dr. Blaine Tharman |
First Address | Manhattan, KS 66503-6404 |
Second Address | Manhattan, KS 66503-6404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2021 |
Last Update Date | 07/07/2021 |